Insomnia (along with its many adverse results) can affect nearly anyone in the world.
Its most common form is secondary insomnia: sleeplessness that is a side-effect of other conditions, like anxiety, stress, restless leg syndrome, hormonal imbalance, body pain, or sleep apnea.
It’s the type of insomnia that’s actually easier to cure as treating the source will most likely improve sleep; in most cases, secondary insomnia is considered acute or temporary.
Primary insomnia is trickier; it’s not caused by any psychiatric, medical, or environmental factor, which makes it harder to treat.
It often results in chronic/long-term insomnia that can stay with the patient for years if left untreated.
That’s where Cognitive Behavioral Therapy for Insomnia comes in: CBT-I is a comprehensive, drug-free, behavioral treatment option that seeks to address every single controllable factor in your life that can affect how you sleep.
CBT-I boasts a 75-80% success rate in improving the sleep of patients with chronic insomnia.
It’s even been shown to reduce and sometimes completely eliminate the use of sleeping pills in 90% of the patients who’ve tried it.
Apart from its proven effectiveness, another awesome thing about CBT-I is the fact that you can actually learn to do it yourself from the comfort of your own bedroom.
CBT-I is Basically a Thorough Breakdown and Application of Basic and Advanced Sleep Hygiene Practices
For the uninitiated, sleep hygiene is not about physical hygiene. It’s about adopting sleep-friendly behaviors and practices.
Sleep hygiene is a collection of habits that can facilitate healthier and more efficient sleep (sleeping in full darkness, sticking to a sleep schedule, not exercising/eating hours before bedtime, and other habits you’ve already read about in countless insomnia-related articles).
In order to fully apply all the basic and advanced sleep hygiene habits detailed in the therapy, you first need to have a complete understanding of your own personal battle with insomnia.
STEP 1: Make a Sleep Diary While Conducting a Thorough Assessment of Your Own Sleep Problems for a Minimum of One Week
Find a notepad/notebook and make a sleep diary by recording the following:
- Time when you got in bed to sleep
- Times when you wake up in the middle of the night
- Time when you actually wake up in the morning
- Approximate time when you actually fell asleep at night
- Actual time spent in bed (awake and asleep)
- Actual time spent asleep
- Naps taken throughout the day
This assessment period is also the perfect time to determine and record other factors that may be contributing to your insomnia:
- Possible presence of medical or psychiatric disorders
- Caffeine, alcohol, tobacco, or drug-use
- Amount/type of food consumed / times when food was consumed
- Amount/type of physical exercies / times when exercises were done
- Thoughts that swim in your head when you can’t sleep or when you awaken in the middle of the night
- Bedroom conditions (lights, noise, temperature), particularly during nights when your insomnia is at its worst
Record all this for a minimum of at least one week, but don’t hesitate to extend the assessment period to two weeks if necessary.
The more you know about your own problematic sleep patterns and the many factors that can affect it, the better you can apply CBT-I.
STEP 2: How to Apply Stimulus Control Based on Your Assessments and Sleep Schedule
After assessment, the next step to laying the foundations for CBT-I is stimulus control: strengthening the bed’s association with sleep and weakening its association with wakefulness.
Here’s what you need to do:
- Only go to bed when you’re actually sleepy. If you’re just fatigued or have low energy, you’re likely to regain energy in bed without falling asleep, which will only strengthen your bed as a cue for wakefulness. Instead, go to bed when you’re actually struggling to stay awake in the middle of reading a book, watching TV, or any other activity.
- If you can’t sleep, get out of bed and only come back to bed when you’re actually sleepy. Do this for either when you wake up in the middle of the night or are just attempting to fall asleep.
- Determine and strictly stick to a regular waking time. If it’s 7AM, then get out of bed by 7AM no matter how you feel about it.
- If you absolutely must nap during the day, stick to just one 15 to 30-minute nap taken about 7 to 9 hours after you awaken/rise from bed.
- Use your bed for only two things: sleeping and sex. Any other activities will only weaken your bed as a cue for sleep.
Apart from strengthening your bed’s mental association with sleep and relaxation, these practices can also strengthen the circadian clock that regulates feelings of sleep and wakefulness.
Armed with these basic sleep hygiene practices, along with a clearer understanding of your own insomnia (via step 1: assessment), you can move on to the next step:
STEP 3: How to Apply Sleep Restriction Therapy or SRT
Sleep Restriction Therapy or SRT can also strengthen your circadian clock, but it’s primarily aimed at eliminating prolonged awakenings in the middle of the night.
This is accomplished by increasing and stabilizing sleep efficiency: the time you spend actually asleep versus the overall time you spend in bed.
For instance: if you spend a total of 8 hours in bed but are only asleep for just 4 to 5 hours of that time, then your sleep efficiency is just 50 to 62.5%, which is exactly as bad as it sounds; if this is the case, you obviously need to increase your sleep efficiency.
However, it’s not as simple as just decreasing the time you spend in bed to match your dangerously low sleeping hours.
As a rule in applying SRT: A minimum of 5.5 hours should be spent in bed regularly, even for insomniacs who sleep less than 5.5 hours regularly.
Additionally, as with any chronic insomniac, your ultimate goal should be to sleep soundly for 7 to 9 hours per night, and in terms of sleep efficiency, the goal of SRT is to attain and maintain an average of 80 to 85%.
So how do you do it?
- Restrict yourself from sleep/going to bed until your scheduled bedtime. Determine the ideal time for bed based on what time you want to wake up in the morning and how many hours of sleep you get on nights when you’re not battling insomnia. For instance, if you want to wake up at 6AM, and your regular non-insomniac sleep lasts for 8 hours, then your ideal bedtime is 9:30 to 10PM.
- If possible, avoid napping anytime during your waking hours. This will increase the likelihood of sleepiness during your scheduled bedtime.
Before you ask, SRT is not aimed at giving you 100% sleep efficiency as that would be ridiculous.
100% would mean falling asleep the moment you hit the bed every single night – virtually impossible under regular conditions.
Instead, remember that the aim is to maintain a sleep efficiency of 80 to 85% – all while getting 7 to 9 solid, uninterrupted hours of sleep.
Adjust your bedtime accordingly until you can maintain those numbers.
When sleep efficiency rises above 85%, extend the time spent in bed by making your bedtime 15 to 30 minutes earlier.
And if sleep efficiency falls below 80%, then you need to further restrict bedtime to 15 to 30 minutes later.
Following these SRT guidelines will ensure that you’re getting adequate amounts of sleep – enough to keep your mind and body functioning normally throughout your waking hours.
STEP 4: Maintain Positive Changes to Your Sleep Patterns Through Relaxation/Stress-Management Skills and Other Sleep Hygiene Habits
Sleep hygiene is an often underutilized weapon in the fight against recurring insomnia.
What a lot of insomniacs don’t realize is that adhering to even the most basic sleep hygiene habits can shift their thinking from having to “try to sleep” to just “allowing sleep to happen naturally”.
Remember and follow these useful sleep hygiene skills and habits:
Stop Looking at the Clock While in Bed
The last time you look at the clock should be right before checking if it’s bedtime. Should you awaken in the middle of the night, don’t look at the clock either; it’ll just raise your anxiety about needing to get to sleep.
Relax and Unwind During the Hour/Couple Hours Before Your Determined Bedtime
This is the best time of the day to enjoy calming activities, like drinking a cup of non-caffeinated tea, or simply listening to music that relaxes you.
Do Not Take Any Caffeine for a Full 12 Hours Before Bedtime
Familiarize yourself with the half-life of caffeine and how long just a cup of coffee stays in your system. If you absolutely have to have a cup, do it a couple hours after waking up.
Unless you’re super sensitive, caffeine is not prohibited during CBT-I; you just need to control your intake.
Do Not Drink Alcohol 4 to 6 Hours Before Bedtime
Yes, it makes you sleepy, but as a mental stimulant, alcohol could be the reason why you keep waking up at night,
Do Not Eat Anything 4 to 6 Hours Before Bedtime
Digestion slows down considerably when we sleep. This means you have to give your body time to digest the food you eat before you go to bed.
Otherwise, indigestion could interrupt your much-needed sleep. If you absolutely have to have a midnight snack, make it something light, sugarless, and non-acidic, like a soda cracker.
Do Not Exercise 4 to 6 Hours Before Bedtime
Mental and physical stimulation comes with exercise. Don’t do it too close to bedtime.
Sleep in a Cool, Dark, and Comfortable Environment
You’ve heard it all before and you need to hear it again: sleep in total darkness, in a room that’s cool, comfortable, and ideal for relaxation.
Do Not Stress Yourself About Falling Asleep
CBT-I is all about natural sleep. Allow sleep to happen instead of trying your hardest to get there. Your very mindset can determine whether CBT-I will work against your insomnia. So do yourself a favor and relax.
Understand Your Circadian Clock and Use Light/Darkness Accordingly
Circadian rhythms are the many roughly 24-hour biological cycles that regulate the human body’s different activities. Your circadian clock is the rhythm that’s responsible for regulating sleepiness and wakefulness.
Simply exposing yourself to bright, natural light tells your circadian clock that it’s time to be alert and awake, prompting your mind and body to respond with energy.
Likewise, staying in the dark tells your circadian clock that it’s time to sleep and relax.
Be Strict About Bedtime, Waking Time, and Practicing Sleep Hygiene
Remember: the only way to ensure that CBT-I works for you is if you apply each and every step properly and accurately; any deviation will decrease its potential efficacy in improving your sleep.
STEP 5: When All Else Fails Consult a Professional
While everything you need to know to do CBT-I at home is literally already in this guide, that doesn’t mean that your research stops here; there’s no shortage of information online when it comes to applying CBT-I.
However, even the internet’s wealth of information might not be enough for some people to properly understand and try this comprehensive sleep therapy.
If that’s the case, then feel free to consult a sleep professional who knows about CBT-I.
Remember: if there’s a possibility that a particular drug-free option can help you defeat insomnia, there’s no harm in trying it.
If Peter Mutuc isn’t sculpting, writing, editing, drawing, skating, cycling, wrestling with his Labrador, or actively regulating his sleeping patterns through at least 150 minutes of weekly exercise, he’s usually just online, creating and developing web content for One Bed Mattress.